Care Home: 4 & 6 Precinct Road

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What the care home does well Precinct Road provides a home environment for people with a learning disability. People who use the service are supported and encouraged to make choices and decisions within their capabilities. Care plans and risk assessments are clearly written, up to date, and contain detailed information on the everyday needs of people who use the service. The home is part of an organisation, which provides a good training package for staff to improve their work skills. Overall the home was found to be clean and hygienic. What has improved since the last inspection? The lounge in House Number 6 has been decorated and refurbished. A clear improvement has been made to the look of this room. A Manager has now been appointed for Precinct Road and registered with the Commission for Social Care Inspection. A team review has been held and improvements and action points have been identified. Recruitment has recently taken place and Precinct Road will now have a full staff team. Staff files have been reorganised and the supervision records seen demonstrated that regular one to one supervision is taking place. What the care home could do better: Although noticeable improvements had taken place with decorating and refurbishment to some parts of the home, action still needs to take place to further improve the home environment for people who use the service. CARE HOME ADULTS 18-65 4 & 6 Precinct Road 4 & 6 Precinct Road, Coldharbour Lane Hayes Middlesex UB3 3AG Lead Inspector Ms Susan Woolnough-Singh Key Unannounced Inspection 8 November 2007 & 9th November 2007 10:00 th 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 4 & 6 Precinct Road Address 4 & 6 Precinct Road, Coldharbour Lane Hayes Middlesex UB3 3AG 020 8581 7351 0208 813 7081 h3m032ward@mencap.org.uk www.mencap.org.uk Royal Mencap Society Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Cara Marie Rickett Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 5 16th February 2007 Date of last inspection Brief Description of the Service: Precinct Road is a care home for five service users with learning disabilities. At the time of this inspection all the service users were male. The home consists of two interconnecting houses (No 4 & No 6) located in a residential area. Three service users occupy No 4 and two occupy No 6. Each house has a lounge, dining area, kitchen, bedrooms and a bathroom. The meals are cooked in No 4 and the laundry is in No 4. The home is close to shops and public transport. New Era Housing Association owns the premises and Mencap provides the care. The staffing level has to be high as the needs of the service users are high. No ancillary staff are employed at the home. The home aims to facilitate the service users to live as ordinary life as possible, to promote independence and to have access to all the external services they require. The service users attend day centres four days weekly. Three are members of clubs for people with learning disabilities. Leisure activities are provided in house and externally. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Inspection of Precinct Road. There had been no changes in people who use the service since the last inspection. The Manager has now been registered with the Commission for Social Care Inspection. The Inspector met the people who use the service and was able to have a general talk with two of them. All of the National Minimum Standards for Adults were assessed. Four statutory requirements were made at the last inspection, which took place on the 16th February 2007. Three requirements had been met; the requirement on improving the environment for people who use the service was only partly met and is repeated in more detail in four new requirements of the six made at this inspection. The home meets equality and diversity issues as appropriate. What the service does well: What has improved since the last inspection? The lounge in House Number 6 has been decorated and refurbished. A clear improvement has been made to the look of this room. A Manager has now been appointed for Precinct Road and registered with the Commission for Social Care Inspection. A team review has been held and improvements and action points have been identified. Recruitment has recently taken place and Precinct Road will now have a full staff team. Staff files have been reorganised and the supervision records seen demonstrated that regular one to one supervision is taking place. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive a Needs Led Assessment prior to moving into the home. The needs of people are reviewed if the home is no able to meet their needs. EVIDENCE: A Mencap Society procedure is in place for the assessment of people who are referred to their residential provision. All of the people at Precinct Road have lived at the home for a number of years; there have been no new admissions since the last key inspection. One person living at the home had expressed an interest in moving into accommodation that would better suit his needs. The home had also forwarded a number of incident reports to the Commission for Social Care Inspection. The Inspector was informed that a move to another service was being considered and an alternative Mencap Society home had been identified. Shortly after the inspection visit the Inspector was informed of the date for a meeting with the area Service Manager to progress the move. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s care needs and goals are reflected in the care plan. Peoples’ likes and dislikes are contained in the care plan and where possible people are encouraged to make decisions. A range of risk assessments are available with risk management guidelines. EVIDENCE: All of the people at Precinct Road have a service user care plan. On this occasion the care plans of three people were examined. The care plan contains information relevant to daily living. There is a section on the plan for communication and the importance of understanding body language, particularly for people who are unable to communicate verbally. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 10 Behavioural Guidelines are covered with information on triggers and the recommended way to manage behaviours that are considered challenging. Daily routines are recorded with likes and dislikes and any day centre attendance. People who use the service are able to make decisions at different levels according to their ability. One person has voiced a wish to be offered alternative accommodation; the staff had acted upon this. For other people who use the service, staff have to be aware of their likes and dislikes, these are documented in the care plan. Each file examined contained a number of risk assessments. Risk assessments cover people going out independently (for one person) household risks and any risk in regard to behaviour. Risk assessments were updated and reviewed in March 2007. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16, and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home have daily routines and various leisure activities, some of which take place in the community. People attend a day centre during the week. These routines are based on people’s needs and ability. For some people there is more family involvement than others. Staff aim to make links where possible. Staff prepare meals, these appeared to be varied and appropriate for the cultural needs of people living at the home. EVIDENCE: People living at the home attend Day Centre; this is usually four days a week with a day off for participating in household tasks such as shopping. The 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 12 Inspector was informed that some people are able to participate in household tasks such as laying the table. One person is able to help staff with cooking. One person who is not confident in social settings has recently started to attend a day centre on occasions. The staff are guided by his wishes on the day. One member of staff had some success with regard to taking this person out for a walk and to a restaurant on a one to one basis. People at the home attend a variety of specialist clubs in the evening and on a Sunday. At a team review it had been identified that an improvement would be to offer more in the way of activities for people living at the home. Team review goals were displayed in the home. Apart from day centre attendance it was not clear if regular planned activities take place. The Registered Manager said that an activity schedule would eventually be drawn up; this is to be recommended. A holiday had been arranged for two people with a specialist holiday company. The staff were in the process of trying to find a suitable holiday for a third person. Outings are arranged to a local theatre. The Inspector was able to talk with one person about activities in the home. He said that a Halloween party had taken place; there had been food and scary music. Staff had come to the party. He said that he goes out to clubs and clothes shopping with staff to a local store and for pub lunches. People living at the home have differing arrangements with family and friends. Where family have not been involved staff said they aimed to encourage contact an example of this was given. The Inspector examined the weekly menus. The Inspector was informed that these include preferred dishes based on people’s preferences. People take a packed lunch to the day centre during the week. The menu consisted of mainly British and pasta dishes. A fruit bowl is available; this is kept in the kitchen cupboard. One person is able to help staff with the cooking. One resident attends church on a regular basis. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive the personal support they need. Clear Guidelines are contained in the Care Plan. Health care support is available for service users as required. There are policies and procedures in place for the safe administration of medication. EVIDENCE: The personal support required by people who use the service is contained in the care plan. At Precinct Road differing levels of support are required and this is reflected. The care plans examined contained detained information on personal care needs. People’s health care needs are recorded in the care plan. Action plans are in place, which set out health care issues to be monitored and arrangements to 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 14 be made. People who have epilepsy have pen pictures, the Inspector was informed that one person had improved health in this area and this had made a difference to his quality of life. One person had seen a dietician for advice on weight loss. Service users do not administer their own medication. The Boots Monitored Dosage System is used for the administration of medication. One member of staff is designated the task of overseeing the medication system. A medication risk assessment and medication policy is in place. Medication storage and the medication administration record were seen. Two members of staff now sign the medication administration record. The medication returns book was viewed. A member of staff and the Pharmacist signs this. No concerns were noted with regard to these. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clear complaints procedure is available for service users. Training and procedures are in place to highlight the importance of safeguarding vulnerable adults. EVIDENCE: A Royal Mencap Society complaints procedure is available and is kept for each person; the complaints procedure is also available in audio version. Since the last key inspection there have been no complaints made about the service. A Whistle Blowing procedure is available. Information on the Annual Quality Assurance Assessment stated that all staff had read and signed the Whistle Blowing Policy and No Secrets Policy. Training profiles for all members of staff were made available. All members of staff apart from one support worker had attended training in the Protection of Vulnerable Adults. The Registered Manager had planned further POVA training with the London Borough of Hillingdon and was waiting for confirmation of the date. People require different levels of support with their finances. Generally, staff assists people with shopping and any transactions. Systems are in place for managing personal allowance. There was reference to budgeting and finances in the care 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 16 plan and review. There is a policy in place for the management of money and financial affairs. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable environment; although both houses do need to be made more homely and facilities improved for the benefit of service users. EVIDENCE: On touring the building the Inspector noticed that improvements had been made to both houses since the last inspection. New net curtains had been purchased for both houses. The lounge in house number six had been improved with new carpets, fresh décor and large floor cushions. Photographs have been put on the walls in both houses. There were plans to purchase new reinforced specially tough furniture for one person for his bedroom. There remain a number of areas in the home where improvement is necessary for standard twenty-four to be met: 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 18 1. The Kitchen Units in house number 4 are old and in places the cupboard doors are not securely fixed. The Inspector was informed that the Service Manager is in the process of getting quotes for replacement. 2. The Laminate flooring is cracked in places. 3. The dining room table and chairs in House number six needs to be replaced. The dining room table is worn and scratched. The chairs are made up of plastic garden chairs of two different colours. 4. The bathroom toilet door in house number four is dented and cracked. 5. In one bedroom the curtains are not hung properly and the television was on the floor. The home was clean and tidy; standards were good in this area. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Royal Mencap Society offers staff the training to support service users in an effective manner. There is sufficient staff on duty to meet the basic needs of the service users. A recruitment policy is in place, which incorporates the required checks on staff and a good process of selection. Supervision and appraisal systems are in place to support staff in their work. EVIDENCE: Staff training profiles were forwarded to the Inspector. A company is used to provide mandatory training in Health and safety related subjects, epilepsy, POVA, medication, consent, and training on valuing people. The Royal Mencap Society offers staff a good induction programme; staff complete a workbook, 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 20 which covers the knowledge and skills relevant to working with adults with a learning disability. The staff team consists of the Registered Manager, Deputy Manager and seven support workers including two night support staff. A minimum of one member of staff is on duty at all times in each house. One member of staff sleeps in with one waking night staff on the premises. At the time of the inspection two more support workers had been recruited but had not commenced employment. Precinct Road now has a full complement of permanent staff, which is an achievement. Staff recruitment policies and procedures are in place. The Inspector looked at the recruitment/personnel files of two existing members of staff. The new staff documents were not yet available. Files contained all the relevant recruitment checks, including a CRB. Although on one file there was only one employment reference as the person had not been in paid employment for a number of years. Interview questions and notes could be seen on each file. A service Manager and Registered Manger form the interview panel. New personnel files had been prepared for all staff. The information was stored in an ordered and accessible manner. Three personnel files were examined for regular recorded supervision. Recent supervision dates were satisfactory; this was a requirement of the previous key inspection. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,39, and 42. Quality in this outcome area is This judgement has been made using available evidence including a visit to this service. The Registered Manager has the skills to administer the home in a competent manner. The Registered Manager had carried out an assessment of the standards in the home for the purpose of completing the Annual Quality Assurance Assessment. The team had identified areas for improvement. Practices are in place for the health and safety of people who use the service and staff. The Registered Manager needs to review health and safety training and monitor food storage. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 22 EVIDENCE: The Registered Manager has registered with the Commission for Social Care Inspection since the last inspection. The Manager has the GNVQ 2, NVQ 3 and is currently studying for an NVQ in Management. The Registered Manager has also completed training in management development such as supervision and appraisal, recruitment and selection and managers competency assessment. A team review had taken place in October 2007. A number of areas had been identified by the staff team for improvement, such as improving the environment and increasing activities. The Registered Manager had completed the Quality Assurance Assessment. The information in this was clear and indicated that the quality of the service had been assessed, strengths and weaknesses identified. MENCAP has a number polices and procedures relating to health and safety. The fire safety folder was viewed; fire drills had taken place in May, June and July. The fire alarm system and emergency lighting had been serviced in April 2007. A work place fire risk assessment had been completed. A fire training information pack was seen, this is used to update staff on fire safety. The majority of staff have received mandatory training in health and safety related subjects. The records indicated that one member of staff did not have food hygiene training and one did not have infection control training. The London Borough of Hillingdon had carried out a Food Hygiene inspection in February 2007. At this inspection on checking the fridge the Inspector found some pre - packed cold meat was uncovered. A monthly work place check is carried out by a Service Manager, health and safety is included in this and the last check was carried out in October 2007. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X x 2 X 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23 (2) (a) Requirement The Registered Provider and Registered Manager must arrange to have the kitchen units in House number 4 replaced. The Registered Provider and Registered Manager must arrange for the bathroom door in house number 4 to be repaired or replaced. The Registered Provider and Registered Manager must arrange for the laminated flooring in house number four to be repaired. The Registered Provider and Registered Manager must purchase new chairs and a dining room table for house number 6. The Registered Manager must review training records to ensure that all staff have received training in food hygiene and infection control. The Registered Manger must ensure that cold meats are stored appropriately. Timescale for action 01/05/08 2. YA24 23 (2) (a) 01/05/08 3. YA24 23 (2) (a) 01/02/08 4. YA24 23 91(2) (a) 12 (1) (a) 01/02/08 5. YA42 01/01/08 6/ YA42 13 (4) © 12/12/07 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 25 No. 1. Refer to Standard YA12 Good Practice Recommendations An activity schedule should be put in place to demonstrate the options and choices people who use the service have in this area. 4 & 6 Precinct Road DS0000027121.V348849.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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